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General NPI Number Information
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NPI Number | 1760475016
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Entity Type | Organization
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Legal Business Name | TIM'S PHARMACY & GIFT SHOP, LTD
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 11/16/2022
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Provider Practice Location Address
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Address Line | 106 1ST ST S
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City | YELM
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State | WA
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Zip | 98597-7700
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Country | US
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Telephone | 360-458-8467
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Fax | 360-206-5157
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Provider Business Mailing Address
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Address Line | PO BOX 5120
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City | YELM
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State | WA
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Zip | 98597-5120
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Country | US
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Telephone | 360-458-8467
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Fax | 360-206-5157
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY SHANE HARRELL
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Credential | PHARMD
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Telephone | 360-458-8467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | CF00002080
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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